Endotracheal tube (ETT) should have intracuff pressure (ICP) in the range of 20 to 30 cm water (H2O). In this observational study, we studied the trend amongst anaesthesiologist in choosing the type of ETT and their ability to assess optimum ICP clinically. After institutional ethics committee approval, we observed 75 patients under general endotracheal anaesthesia in Government Medical College. Anaesthesiologists were blinded to study purpose. The type of ETT used and magnitude of ICP was recorded. ICP was measured using simple aneroid manometer. Once the pressure was measured, it was readjusted to normal range and nitrous oxide was allowed to start. Red rubber tube was used in 18.7% and polyvinyl chloride (PVC) in 81.3% cases. The anaesthesiologists were not able to assess ICP in the recommended range clinically in 100% cases when red rubber ETT was used and in 40% cases when portex ETT was used. Red rubber ETT (reusable) with low-volume high-pressure cuff is still in use, though the trend is shifting towards more of using PVC ETT. Anaesthesiologists were not able to inflate the ETT cuff to the recommended range in spite of their clinical expertise (more than 5 years of teaching experience) in significant number of cases. We recommend the use of simple aneroid manometer for objective monitoring of ICP over subjective assessment, not only in red rubber, but also in PVC ETT.

Background:Laryngeal mask airway (LMA) C Trach is a novel device designed to intubate trachea without conventional laryngoscopy. The aim of the study was to evaluate the clinical efficacy of C trach in the simulated scenario of cervical spine injury where conventional laryngoscopy is not desirable.Methods:This prospective pilot study was carried out in 30 consenting adults of either gender, ASAPS I or II, scheduled for surgery requiring endotracheal intubation. An appropriate sized rigid cervical collar was positioned around the patient's neck to restrict the neck movements and simulate the scenario of cervical spine injury. After induction of anesthesia, various technical aspects of C Trach facilitated endotracheal intubation, changes in hemodynamic variables, and complications were recorded.Results:Mask ventilation was easy in all the patients. Successful insertion of C Trach was achieved in 27 patients at first attempt, while 3 patients required second attempt. Majority of patients required one of the adjusting maneuvers to obtain acceptable view of glottis (POGO score >50%). Intubation success rate was 100% with 26 patients intubated at first attempt and the rest required second attempt. Mean intubation time was 69.8±27.40 sec. With experience, significant decrease in mean intubation time was observed in last 10 patients as compared to first 10 (46±15.77 sec vs. 101.3±22.91 sec). Minor mucosal injury was noted in four patients.Conclusion:LMA C Trach facilitates endotracheal intubation under direct vision and can be a useful technique in patients with cervical spine injury with cervical collar in situ.

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